They are trying to close an A&E [ER] department in Casualty. In Holby City more and more patients have to be transferred to specialist centres elsewhere. In No 10 they wish everyone could understand what the scriptwriters do: the NHS is changing.
The voters certainly dont get it. It used to be Labours boast that it was the party of the NHS. And it was true: every single poll showed Labour ahead of the Conservatives on the health service, always. Until this summer. In the past ten years Labour has achieved the extraordinary feat of turning a 49-point lead over the Tories on health into a four-point lead for the Tories (Ipsos MORI). Thats a stunning fall at a time when spending on the NHS under Labour has ballooned from £35 billion to £80 billion, and waiting lists have fallen from 18 to six months.
In part the decline reflects growing cynicism about the Government in general, in part it is a riposte to overblown promises about saving the NHS. Ten years after promising to save it, the health service has a £500 million debt and 60 hospitals are threatened with closure or downgrading.
What went wrong? First, not as much as it sounds. The debt isnt a lot for a health service with a budget of £80 billion. Gordon Brown could flick that away with a stroke of his pen, or his big clunking fist.
Nor is it on the whole that the Conservative Party is trusted more with the NHS; Labour is just trusted less. Four in ten people say that they dont know who would do the best job any more.
Thats the good news for the Government. The rest is bad. With hospital closures imminent and a ferocious Conservative assault on the territory, including a cheeky campaign to stop Browns NHS cuts, Labour is worried. Not quite worried sick, but it should be.
The drive to cut the debt has coincided with a big push towards reconfiguration of services hospital closures to you and me. It is almost impossible now for ministers to disentangle in peoples minds the idea that the local health service is in debt with the fact that their hospital is under threat. The Government argues that the closure or downgrading of some hospitals was always implicit in its reforms, regardless of the current financial difficulties, as some treatment was brought closer to the people while greater specialisation saw fewer, more specialised hospitals. I dont remember them championing hospital closures when they published their reform programme, the NHS Plan, six years ago. It was an implicit not an explicit part of it.
The area I live in is in debt and has a number of hospitals under threat. Throughout Surrey and Sussex, in East Anglia and other threatened areas, this is the big conversation. It dominates local media. What ministers may have hoped could be contained in a few mainly Conservative rural areas has spilled over into the national press, and they havent even started shutting any of the hospitals yet. We are in a pre-consultation planning period, when health authorities are drawing up plans for public consultation next year, and rumours abound as to what hideousness they may contain. The vacuum of information is filled by local GPs, who tell patients they cannot take on the extra work the Government says they are going to do when the hospital closes: no staff, and no space to expand the surgery.
What mastermind at the heart of government, I wonder, planned this? And planned it so perfectly that the next election is going to coincide with massive hospital cuts?
Its the right thing to do, they repeat. Tony Blair is not for turning. Fewer, more specialised hospitals will be safer for patients who will end up overall with better services, not worse. And what is more, we wont get to the maximum 18-week wait between GP referral and treatment by the end of 2008 unless we do it.
So between spring next year and the end of 2008 the Government is simultaneously going to jump through the hoops of closing hospitals, reorganise local services, open new treatment centres and make the biggest, deepest cut yet in waiting lists? Forget it.
There is a broader tension in government policy that nobody can resolve: just as it claims to be bringing care closer to the people, it is planning to take local A&E and maternity departments further away from them. Local health planners calculate how long an ambulance with a flashing blue light might take to reach the specialist hospital, not an ordinary driver distracted by a sick family member in the car. Ministers have realised that these are the issues that have to be addressed, tangibly, in the local reorganisation proposals, which is why they have been put back until next year.
Lets assume that the Government is right and a lot of conditions asthma, diabetes, heart disease, arthritis as well as many minor operations could be better and more cheaply managed in local communities or at home than in big hospitals. Lets allow too that superhospitals with knobs on have a better chance of saving the life of a seriously injured person, and that babies are marginally more safely delivered in larger specialist centres (which is why mothers at high risk will be transferred there anyway).
That still wont answer the local problem. People do not feel safe without access to an A&E that they can reach within a reasonable time. They would prefer to have their babies in a local hospital, which means maintaining a full maternity unit there were some terrible problems in Kidderminster when the maternity unit was downgraded to a midwife-led one. And when a baby is born, or someone is taken ill in the night, the family wants to be able to visit the next day, without making a two to three-hour round trip, plus the visit time.
These are human needs outside the medical charts, and the Government has failed to grasp them. I wonder if its too late to ask Casualtys scriptwriters for help.
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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